Subutilization of COPD Guidelines in Primary Care

Laniado-Laborı́n, Rafael; Rendón, Adrián; Alcantar-Schramm, Juan Manuel; Cazares-Adame, Rebeca; Bauerle, Otto

doi:10.1177/2150131913475817

Cited by 13 publications

(8 citation statements)

References 14 publications

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“…The results of the PLATINO survey suggest that primary care physicians may require additional training to better manage COPD patients in Latin America [84,85]. Integrated programs, such as the Practical Approach to Lung Disease [86][87][88][89], may help manage COPD as well as other respiratory conditions such as acute respiratory infections, pneumonia, tuberculosis and others depending on the country or region.…”

Section: A Primary Care Approach To Copd In Latin Americamentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease in Latin America

Pérez‐Padilla

Menezes

2019

Annals of Global Health

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Background Latin America covers a vast geographic area (larger than the United States, Canada or Western Europe) with about 600 million inhabitants distributed in at least 19 countries. The population tripled since 1950, with a massive migration from rural areas to cities. Latin America is a mixed pot of ethnicities including the European, African, Mulatto, Mestizo and Amerindian individuals, in various proportions depending on the native population prior to the arrival of Europeans and the extent of European and African migration. Unfortunately, Latin America is one of the areas in the world with the widest disparity in income within and between countries, leading to a coexistence of diseases of poverty with those seen in developed countries. Tobacco-induced diseases, diabetes, obesity and the cardiovascular disease typical of developed regions and infectious diseases and problems related to violence often overlap in the same country. Prevalence of COPD in Latin America: Data from Population-based Studies Before several population-based surveys conducted in the early 2000s, information on respiratory diseases was very scarce, beyond the compulsory data provided by the World Health Organization (WHO), mostly based on mortality statistics. The Global Burden of Disease (GBD) project (the latest conducted in 2013) [1] provided estimates

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Section: A Primary Care Approach To Copd In Latin Americamentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease in Latin America

Pérez‐Padilla

Menezes

2019

Annals of Global Health

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“…The evidence-based guidelines available to aid physicians in the management and treatment of patients are frequently not fully implemented in clinical practice, as demonstrated across many regions worldwide. 4 – 11 Reasons for this include a lack of familiarity with guidelines and a lack of confidence in implementation and access/time constraints, 9 – 11 but have also been shown to be associated with physician perceptions and beliefs about COPD management. Yawn et al 10 reported that among 278 primary care physicians (PCPs) and practice nurses/assistants, only 15% thought COPD treatments were very or somewhat useful and 3% thought pulmonary rehabilitation was useful or very useful, despite its availability to 32% of those sampled.…”

Section: Introductionmentioning

confidence: 99%

Continuing to Confront COPD International Surveys: comparison of patient and physician perceptions about COPD risk and management

Menezes

Landis

Han

et al. 2015

COPD

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PurposeUsing data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians’ attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) prognosis, and compares physician and patient perceptions with respect to COPD.MethodsIn 12 countries worldwide, 4,343 patients with COPD were identified through systematic screening of population samples, and 1,307 physicians who regularly saw patients with COPD were sampled from in-country professional databases. Both patients and physicians completed surveys about their COPD knowledge, beliefs, and perceptions; physicians answered further questions about diagnostic methods and treatment choices for COPD.ResultsMost physicians (79%) responded that the long-term health outlook for patients with COPD has improved over the past decade, largely attributed to the introduction of better medications. However, patient access to medication remains an issue in many countries, and some physicians (39%) and patients (46%) agreed/strongly agreed with the statement “there are no truly effective treatments for COPD”. There was strong concordance between physicians and patients regarding COPD management practices, including the use of spirometry (86% of physicians and 76% of patients reporting they used/had undergone a spirometry test) and smoking cessation counseling (76% of physicians reported they counseled their smoking patients at every clinic visit, and 71% of smoking patients stated that they had received counseling in the past year). However, the groups differed in their perception about the role of smoking in COPD, with 78% of physicians versus 38% of patients strongly agreeing with the statement “smoking is the cause of most cases of COPD”.ConclusionThe Continuing to Confront COPD International Surveys demonstrate that while physicians and patients largely agreed about COPD management practices and the need for more effective treatments for COPD, a gap exists about the causal role of smoking in COPD.

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“… 4 – 7 A large web-based survey in 2011 of primary care physicians (PCPs) across the regions of Asia Pacific, Africa, Eastern Europe, and Latin America showed limited knowledge of COPD guidelines, including underutilization of spirometry for diagnosis of COPD and a general lack of awareness about the significance of exacerbations as an important factor in the management of COPD. 8 Country-specific surveys largely conducted in primary care in Western Europe, 5 , 6 , 9 – 11 Japan, 12 Mexico, 13 and the USA 14 – 16 have also shown that despite knowledge of guidelines, there is a lack of adherence to guideline recommendations for the treatment of COPD. In the USA, the main barriers to guideline implementation have been reported as low familiarity, low ability or confidence in interpreting recommendations, time constraints, and low outcome expectancy among physicians.…”

Section: Introductionmentioning

confidence: 99%

Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

Davis

Landis

et al. 2014

COPD

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AimUtilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians’ knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists.Materials and methodsPhysicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios.ResultsPhysicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001) to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001). Respiratory specialists were more likely than PCPs to report awareness of the GOLD global strategy (93% versus 58%, P<0.001); however, when presented with patient scenarios, they did not always perform better than PCPs with regard to recommending GOLD-concordant treatment options. The proportion of PCPs and respiratory specialists providing first- or second-choice treatment options concordant with GOLD strategy for a GOLD B-type patient was 38% versus 67%, respectively. For GOLD C and D-type patients, the concordant proportions for PCPs and respiratory specialists were 40% versus 38%, and 57% versus 58%, respectively.ConclusionThis survey of physicians in 12 countries practicing in the primary care and respiratory specialty settings showed high awareness of COPD-management guidelines. Frequent use of guideline-recommended COPD diagnostic practices was reported; however, gaps in the application of COPD-treatment recommendations were observed, warranting further evaluation to understand potential barriers to adopt guideline recommendations.

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Subutilization of COPD Guidelines in Primary Care

Abstract: Despite the existence and availability of evidence-based guidelines, only a minority of primary health care COPD patients in Mexico are receiving state-of-the-art treatment at the primary care level.

Cited by 13 publications

References 14 publications

Chronic Obstructive Pulmonary Disease in Latin America

Chronic Obstructive Pulmonary Disease in Latin America

Continuing to Confront COPD International Surveys: comparison of patient and physician perceptions about COPD risk and management

Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

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